Credentialing Coordinator

1 month ago

Phoenix, United States Blue Cross Blue Shield of Arizona Full time

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

PURPOSE OF THE JOB

The Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers in alignment with State, Federal, and NCQA standards.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

•2 years of experience in a healthcare field

•2 years of experience in provider credentialing

2. Required Education

•High-School Diploma or GED in general field of study

3. Required Licenses

•N/A

4. Required Certifications

•N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

•2 years of experience in a healthcare field, preferably within a credentialing/recredentialing environment and knowledge of national accreditation and/or regulatory standards

2. Preferred Education

•Associate's Degree in general field of study

3. Preferred Licenses

•N/A

4. Preferred Certifications

•Certified Provider Credentialing Specialist (CPCS)

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

•Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations

•Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes

•Identify and communicate agenda items for Credentialing Committee to immediate leader

•Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file

•Promptly address incoming files for processing

•Review and maintain all applications for accuracy and completeness

•Accurately and efficiently data enter primary source verification data into the credentialing database

•Input credentialing decisions and dates into the credentialing database

•Generate and mail approval letters to participating providers

•Identify missing or erroneous information from the provider's application, and communicate with the provider to obtain

•Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process

•Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing

•Maintain ongoing participation in cross-training activities

•Provide recommendations and feedback regarding process improvements and/or standardization practices

•Actively participate in staff meetings, team huddles, and one-on-one meetings

•Engage in team building activities

•Perform all other duties as assigned

•The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

•Verbal and written communication skills

•Maintains confidentiality according to policy

•Effectively communicate with internal and external customers via telephone and email

•Accurately receive information through oral communication

•Accurately review data and figures both in hard copy and electronic formats

•Accurately sort through data and think through issues in a time-pressured environment

•Accurately learn and retain new information, knowledge, and skills

•Efficiently manage multiple tasks, with varying degrees of priority, at the same time

2. Required Professional Competencies

•Ability to think critically

•Strong attention to detail

•Excellent organizational skills

•Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels

•Maintain a calm and collected presence while addressing the concerns from an internal and external customer

3. Required Leadership Experience and Competencies

•N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

•Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred

2. Preferred Professional Competencies

•N/A

3. Preferred Leadership Experience and Competencies

•N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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